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Sample Record for 2017-05-19-1

Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.

Project Information

Project ID: 210914 DEA: 07306204 EFIS: 0714000151 QA Service Level: 1
DIST-CO-RTE-PM: 07-LA-91-R11.3/R20.7
Work Description: ROADWAY REHABILITATION
Location Description: IN LOS ANGELES COUNTY, BETWEEN I-710 IN LONG BEACH AND 183RDSTREET IN CERRITOS
Contractor Name: USS CAL BUILDERS
Contractor Address: 8051 Main Street, Stanton, CA 90680
Resident Engineer: Kelvin Tran Structure Rep.: Nabil Shmara

Sample Information

DIME Sample ID: 2017-05-19-1
TL Number from the TL Form: Unknown
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Quality Assurance
Type of Material: SMTL TM7 - Epoxy Coated Dowels
Sample Taken Date: 05/19/2017
Date that the sample was received by the laboratory/organization performing the testing: 05/22/2017
The quantity of what the sample constitutes: 2
A brief description of the sample: Epoxy Coated Dowel Basket
From where was the sample collected: Source
Laboratory sample identification: Unknown
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Dayton Superior Modesto

Material Information

Dowel Metal Heat Number: 17102445
Dowel Epoxy Batch Number: 7396024285
Dowel Coating Specification: ASTM A775
Dowel Size: 1.5 in
Dowel Coating Color: Green
Dowel Manufacturer: Dayton Superior
Dowel Coater: Dayton Superior
Release Number: 1320744-1
Quality Assurance Code: Unknown
Rebar Size (#):
Test results on following page(s): 2

Test Results

Test 1 of 2

DIME Test ID: 2017-05-19-1-2
Test Method: ASTM A884-13: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Holiday)
Verified Date: 05/24/2017
Date Tested: 05/23/2017
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
Total Number of Holiday 0
Total Length 3 ft
Holidays Per Linear Foot of Bar 0 holiday per ft
Holiday Test Pass/Fail Pass

Test 2 of 2

DIME Test ID: 2017-05-19-1-3
Test Method: ASTM A884-14: Standard Specification for Epoxy-Coated Steel Wire and Welded Wire Reinforcement (Epoxy Coating Thickness)
Verified Date: 05/24/2017
Date Tested: 05/23/2017
Submitted By Organization: CT HQ - Sacramento Structural Materials Testing Laboratory
Organization Address: 5900 Folsom Boulevard,
Organization City: Sacramento
Organization State: CA
Organization Zipcode: 95819
Organization Email: joshua.moore@dot.ca.gov
Organization Phone: (530) 329-6527
General Comments for this Test:
Test Result Compliance:
Additional Comments When Verified:
First Bar Mean 10.74 mils
Second Bar Mean 11.04 mils
Lower spec. limit LSL 7 mils
Upper spec. limit USL 40 mils
Total mean value 10.89 mils
Total number of values less than LSL no data
Total number of values greater than USL no data